Is Thoracic Spine Extension Work Necessary? – Part 1

Written on January 19, 2014 at 10:57 pm, by Eric Cressey

Today’s guest post comes from my friend and colleague, physical therapist Eric Schoenberg. Eric is an integral part of our Elite Baseball Mentorships, and here, he kicks off a three-part series that I think you'll find very educational – even if it is a bit "geeky" along the way. It'll test what you know and make you question some of the stuff you do with your training and work with clients. -EC

I’ll start by saying this is a classic case of giving an athlete what they need, not what we predict or assume they will need. Let’s be clear up front: there are a lot of athletes that lack thoracic extension and rotation and certainly can benefit from T-spine mobility work. This is especially true for your general population clients that live in flexion all day – although not every “average joe” is stuck in flexion; this is a wrong assumption! However, for the purpose of this series, I am going to make a case for the following statement:

In fact, to take it a step further, I would argue that in some cases, performing these types of exercises will actually make the athlete worse.

During our Elite Baseball Mentorship in August, I mentioned in passing during the postural examination portion of the breakout session that a lot of athletes present with flattened thoracic spines and some are actually relatively extended. I followed this up by stating that some people don’t really need any T-Spine extension work. This simple statement was met with a lot of surprise and follow up questions.

As a result, Eric and I thought it would be a good idea to explore this concept in greater detail. As is often the case, a relatively benign statement takes on a life of its own and turns into a multi-part blog series. As we develop these concepts, please feel free to share your thoughts and experiences in the comments section below.

The general assumption of the group was that everyone was kyphotic and T-spine extension was a default group of exercises that EVERY athlete needed. This premise, however, does not take into account a host of key considerations, such as:

Timing and amount of relative T-spine extension and rotation in the pitching delivery. (covered in part recently by Matt Blake and Eric C. here and here.)

In an attempt to properly define thoracic spine extension with respect to the baseball player, we must first look at functional anatomy. The thoracic spine, with its rib attachments from T1-T10, is built for stability – most notably to protect the internal organs. In addition, the T-spine has thinner intervertebral discs, a feature that adds to its relative inflexibility. The sagittal alignment of the thoracic spine is kyphotic: 40 degrees in adults. (Neumann D.A. 2002). With that said, we are not really talking about the T-spine being “extended”, but instead are talking about the relative amount of flexion that an athlete is in. With that description, it’s important to appreciate that T-spine extension drills are working to put an athlete into an acceptable amount of flexion! It is this flexion (or convexity) that provides a surface for the concave, ventral surface of the scapula to “float” on and create the scapulothoracic joint. (medial border of scapula and ribs 2-7).

For these reasons, we need to not just label an athlete as being “kyphotic” or having a “flat T-spine.” Instead, we should attempt to define which segments of the T-spine have static or dynamic alignment issue and/or movement dysfunction and address them accordingly.

An important concept to look at is the T-spine is comprised of 12 vertebrae, so we will often find components of flexion, extension, and rotation within those 12 segments. Crosbie, et al. reports that the majority of T-spine extension occurs in the lower T-spine during overhead arm movement. This makes sense due to the thoracolumbar junction and the shape of the lower thoracic vertebrae. The T10-T12 vertebrae are similar in size and function to the lumbar vertebrae. T10 has a different rib articulation than T2-9 and T11/T12 have no facets on their transverse process for rib attachments (thus, increasing relative mobility). So, more often than not, when we see anterior pelvic tilt, and lumbar extension compensation, we can assume that the lower T-spine is doing the same thing. So what if, for the purposes of this article, we grouped the lumbar spine as T10-L5?

As a quick aside, it is recognized that the thoracic spine moves in three planes of motion. More specifically, with respect to the frontal and transverse plane, with single arm elevation, the upper T-spine (T1-T5) has ipsilateral coupling of the lateral bending and rotation, whereas in the mid-lower T-spine T6-T12, we see contralateral coupling of lateral bending and rotation. So in the frontal and transverse planes, the T-spine essentially works as two distinctly different subgroups. This is important to consider when prescribing exercises to address a perceived movement impairment. In addition, it is important to remember that the thoracic spine and hips (along with a stable lumbar spine) provide the rotational separation needed to excel in the game of baseball. However, for the purposes of this article, we will focus on the sagittal plane motion of flexion/extension.

As we continue to look at the sagittal plane, but shift our focus to T1, we see a smaller vertebrae (see picture above) that more resembles C7 (and other cervical vertebrae) than the caudal segments (T2-T9). A case can be made that T1 (cervicothoracic junction) functions more like a cervical vertebrae than a thoracic vertebrae.

This leaves us with T2-T9: eight segments with an extreme mobility problem! This is where we are really trying to mobilize “out of too much flexion” to get to an acceptable (neutral) position to allow for enough scapular (namely upward rotation and elevation) and glenohumeral motion to give us enough “space” to throw a baseball without causing an impingement.

So how can we be sure that we are following all these rules in three planes of motion when we are performing our T-spine mobility drills? Are we in fact gaining motion in the correct segments within the context of their coupled motions? Or, are we simply “mobilizing” what moves easiest and taking the “path of least resistance”?

Check back later in the week for part 2 of this series to read more about evaluation of static alignment and movement testing. In addition, we will discuss how scapula position can fool us and (in part 3) how too many “abs” can be a bad thing.

In addition, if you’re interested in more information like this, we would love to see you at one of our Elite Baseball Mentorship, with the next one taking place in June. Click here to learn more.

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This is a great article that I wish all providers that deal in physical medicine and/or with athletes would read.

I am constantly seeing and addressing thoracic mobility issues. I can say that over 90% of my patients, regardless of their presenting complaints, have thoracic mobility problems that directly or indirectly affect their recovery rate. Given that most people present to the chiropractor with low back or neck complaints, that is understandable. Throw in those with upper extremity, shoulder girdle, pelvic girdle and lower extremity issues, and who is left?

Given that core stability is so critical to proper function of nearly all ambulatory motor patterns, thoracic mobility must be investigated and addressed. From a biomechanical, kinesiological, myofascial and even neuromuscular perspective, thoracic function (both spine and rib cage) is paramount.

I have forwarded your article to several. You have done a terrific job of outlining the foundation for what I hope to be a terrific perspective on this very important issue.

Alright Mr.Schoenberg, you win this one. Wow. I was wondering though, any thoughts on how to take this level of detail to a class-based setting where you don’t have the luxury of working one on one with a client?

Excellent teamwork and collaboration on a very useful topic. Not “geeky” at all; the education is really helpful for those serving both athletes and general population trying to live an active lifestyle. This dovetailing between fields is excellent.

“with single arm elevation, the upper T-spine (T1-T5) has ipsilateral coupling of the lateral bending and rotation, whereas in the mid-lower T-spine T6-T12, we see contralateral coupling of lateral bending and rotation”

I was not taught this in my manual therapy education dealing with the T-spine.

Interesting but don’t know if the T-Spine issue is related to problems experienced by my son who is 16 year old and is a left handed pitcher that developed a “Stress Response” issue primarily in thelumbar region. Would the T-Spine Extension excersis work with this condition?

Thanks for reading. The text below has a nice description of T-spine kinematics.

Kinesiology of the Musculoskeletal System
Donald A. Neumann

@Scott:

This is a very common question that comes up in our mentorship program. It is always more challenging in a group setting vs. one-on-one, however your assessments should be individualized and getting familiar with postural and movement assessment should make it easier to line your group up and start seeing things more clearly. We will hit on this in parts 2 and 3 of the series. Also, try taking pictures or using video and then go back and check on things on your own time after the group sessions. Thanks for the question!

@Dennis Brown: Impossible to say without evaluating your son. If the issue is arising from your son being aggravated by spinal rotation he will have to build tolerance for that movement before he can pitch asymptomatically. If he has suboptimal hip drive, in this case specifically meaning that he is generating power from spinal motion instead of hip motion, then he will need to learn to generate power from the hip and then incorporate that into his pitching.

There’s probably no accurate statement that can be made in regard to your question other than “We would need to evaluate your son in person to see where the deficiencies are. There are other issues that could also be causing his problems, and it would be worth exploring them.

Since learning how your body works, or in this case your son’s body, is a key factor in being able to recognize where improvements can be made in an individual training program I will suggest that you buy and read Dr. Stuart McGill’s “Ultimate Back Fitness and Performance.” There’s no one book that will teach you everything you will ever need to know, but this one will help you understand the complexities of the issue and define a 5 stage strategy for building peak performance that exceeds what was possible pre-injury, while allowing the injury to heal and protecting from further injury.

Dr. McGill has worked with an enormous number of elite athletes, as well as regular people, and has an incredibly lucid approach to the body. It is the same one that I have believed in for many, many years: The body is a machine, and must be approached with engineering principles in mind. That’s really what biomechanics is all about, and you can learn what this means for the spine.

Combining that resource with Eric Cressey’s experience with pitchers (and his team’s) should give you as much of a chance as anyone could possibly have to not only help your son recover from his issues but to avoid future problems while being able to excel in his sport.

Good questions and a good response by Joshua. I would add that the best first step would be to seek out and consult with a good medical professional in your area to supplement the research and remedies you come up with on your own.